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INSTA LLER'S NAME ADDRESS
B U 1•L D E R OR OWNER
DATE PERMIT ISSUED
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DATE COMPLIANCE ISSUED 90177
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No..... 5��....... 00...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town . of ...Barnstable..................................................
Appliration -fur Mfipvii l 19orks Tonstrurtion Vrrmft
Application is hereby'made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at: I
Location.Address or Lot No.
CharlesRiley. ------..... T Y n s........................................................................
O ner Address
Joseph P. MacomoEgr & Son Inc Cnterille
......................... --................................... -------•-••---••-------
Installer Address
Type of Building Size Lot----------------------------Sq. feet
V Dwelling—No. of Bedrooms----•---------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------------
W Design Flow............................................gallons per person per day. Total daily flow---------------------------------------.....gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter----.--_-...... Depth...._._...----
x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area......-.------ ----.sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area........_.....__-.sq. it'
z Other Distribution box ( - ) Dosing tank ( )
Percolation Test Results Performed by--------- ----•-----------------------•--....--•---------•--------------.- Date----------------------------------------
�a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water.........,._.-----------
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_--------_-----.----
04 ....................................................----•------•---------------•--•---••--••-•-----•.......................................................
0 Description of S oil------Sand__&-.Gravel---•----------------------------------
x
U -------•-•---------------------------------------------------------•-••--------------....-----••--•---•----------••----•---...---..........-•--•-------•-----------------............-------------
W .....--•-•-•------------------- ---- -------------------•---•-------------•-•-•-....•-=-----•---------......•-•------------•-----------------------------.....-----------------------------------------
UNature of Repairs or Alterations—Answer when applicable...1-NQ..-gallon-__Pit...__overflow-__----_-....
-----------------------------------------------------------------------------------------------•-----------------.._....-------------------------....--------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article lI of the State Sanitar de—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has��en lss ed by the boar of he t
Signed _ •---- ... .......
' . -�t ��
----
Date
ApplicationApproved By....... f� ----------------------------------------------------------.--------------------
Date
Application Disapproved for the following reasons:.................................................................................................................
----------------------------------------------------------------------------------------------------•---•-----•---•---••-•----------•-•--••------------...........------------------.
Date
PermitNo...... /...................................... Issued........................................................
Date
- ------------
--- -
No.--- f '--•--- Fmc.:r ..j............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
{1Ot: 1. ........._....OF....Ba r-.'-sta-le
�._ _. ..-.......................................................
Apphru aan -for Bhtip ial Eurkii Tonstrurtion Prrulit
Application is hereby'made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal
System at:
Location-Address or Lot No.
r to • �,_ r_q y�
V 1!11 .. Z d.1 .S
.� _1,.�J_ . ii�
Owner Address
w J.): 17'" P. 7.11ac i. :.,r T ic Center r_I le A
Installer Address
Type of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
per, Other—Type of Building ---------------------------- No. of persons--__________________-_...__ Showers ( ) — Cafeteria ( )
Q' Other fixtures
W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons.
Septic T,-nk—Liquid capacity------------gallons Length---------------- Width.......--------- Diameter---------------- Depth----------------
xDisposal Trench—No_.................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft.
Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area------------------sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------------------ -------------------••-•-----•••---••••• --- Date_---•-------------•-•-•----------------
a Test Pit No. 1................min utes per inch Depth of 'hest Pit.................... Depth to ground water--_-_-_--__--____----
f4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
1:4 -•------------- ------------------------------------------------------------------------------------------------------------------------------------------
O n n =-
Description of Soil------S.�?_.------'��;_..:""t`'---.'�-1------------------------------------------------------------------------------------------•---------------------------------
x
W
U Nature of Repairs or Alterations—Answer when applicable._-z'�_-'_ ..--_____`-_ —'-�?-_.__ -�__.__ _y Sri rG'-•
------- ............... .............................. ----------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board.of health!
Signed. -'-- y1 / = l/_/l7 (a7 - JL- ' / ! �'J
f Date '
Application Approved BY---- `
-----•••----•-------- -•------------
Date
Application Disapproved for the following reasons_______________________________________________________________________________•._.._________...___._..__________
--------------
Date
PermitNo.----- ..................................... Issued.......................................................
Date
4 A
`.TH`E COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
nat.-n Bar'wtnUle
..........................................OF.....................................................................................
'WrWrtifiratr of Tlimphatirr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Jc P _acori,,o .s Za�i T ic .•
�'• r, Installer
at S, :,?^ , Ott'. �i'� _��?, 1
Rl e�
has been installed in accordance with the provisions of Article Xl'of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No------------ y------------------- dated-........7.f'-----------------------------------
THE ISSU;ANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUN ION SATISFACTORY.
DATE_..----••••. l/
-�-------------�-�. ----_..--•------...------ Inspector-- -_----- ---- --------------------------------------------------••----------
.IIII/
THE COMMONWEALTH OF MASSACHUSETTS v
BOARD OF•`'H ALTH S
l off': Barn�tr:.1e
` . ............OF.. - .-------------- ----------------------------------------
No---
FEE........................
Binpjaiittl ark-s (1-11"amitrurtilln Prrmit
Permission is hereby granted-..._Jnc�r']?i?_. s_.__............................................- bo -t-•�
..............................................................
to Construct ( ) or Repair (X) an Individual Sewage Disposal System
{ r s lip *, I
at No..............................................................................................'---•-•-••...-••=••-- ••••--••-_.=`__'.;•- •-••----••---------•- • ------ - -------------------------------R:i.1e�T
Street
as shwyn on the application for Disposal Works Construction Permit No....j4"l1_______ Dated___-a�_�-_A__!A��'.1-. .......
Board of He �.
DATE.......�'� 6:.' -7 -)-----------------------------------------
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERSy "�"ws'��.- ,•,F�..